Flight nursing with OB specialty

Rio, ASN, RN · Sep 15, 2008

We recently had a case where a pregnant woman was being transferred to another facility when she started to seize during the flight. The flight crew which according to them "had no OB experience" decided to stop at our facility to make sure the baby was ok. We ended up admitting the patient and dealing with her seizures, but here's my question.....Are there flight teams that are OB trained? Do they hire high risk OB nurses to accompany these patients during maternal transports?

Hi Lizzy,

Could you please clarify that you actually heard them say: "had no OB experience." My next question is: What was the crew configuration ? Two RN's or RN/RRT or RN and Paramedic.

Its hard for me to believe that an unqualified flight team was sent on this transport. They may have not been very good at high risk OB but I just can not fathom being sent on a call without experience or training in that area.

Not all flight nurses have an OB background (but we love it when they do, PLUS the other pre-req's), most have some combination of ICU and ER (and although in the ER there is some OB, it is minimal). However when you are hired and the program does high risk OB then, in my experience, you are trained to care for high risk OB and in my program we need to maintain compentancies QUARTERLY... every 3 months we do at least 4 hours each in L&D and the NICU. (plus every other specialty you can think of including OR for intubations and SIM man). we also must maintain NRP and all the rest.

We have Standards of Care that outline our programs plan for treating HROB: everything from Trauma and Pregnancy to Pre-term labor to Pre-ecampsia and eclampsia and HELLP syndrome. We carry Mag Sul/Pitocin/Terbutaline/Hydralazine/Labetalol...etc... When we do a transport we ALWAYS receive report/assess the patients and then call the receiving OB and update them before leaving. If we run into some problem that my partner and I should not know the answer or have a question then we call our Medical Director AND NEVER has he ever chastised anyone for calling. So as far as my personel experience I feel comfortable transporting MOST HROB... exceptions like Mom's at 7cm and pushing, then she is not getting in the Helicopter.

LizzyL&DRN · Sep 15, 2008

Rio,

I wasn't actually there that night but according to the nurses that were working the flight crew did say "we don't have OB experience" . Also according to the nurses that were working that night, the flight crew was saying they wished some of us would come work for them to accompany them on transports like this. Mind you....we are all ACLS certified but very few of us have ER or ICU experience.

My director is looking into forming a maternal transport team like the NICU has.

Thanks for your reply.

core0 · Sep 16, 2008

We recently had a case where a pregnant woman was being transferred to another facility when she started to seize during the flight. The flight crew which according to them "had no OB experience" decided to stop at our facility to make sure the baby was ok. We ended up admitting the patient and dealing with her seizures, but here's my question.....Are there flight teams that are OB trained? Do they hire high risk OB nurses to accompany these patients during maternal transports?

At a previous hospital we had separate teams for high risk OB. These were high risk OB nurses that went along on flights. They usually displaced the RT when they went. Ie usual configuration is RN/RT or single RN. The NNP on the other hand was usually NNP/RT.

David Carpenter, PA-C

FutureCRNA09 · Sep 23, 2008

Our program uses a 2 RN configuration, and we do have HROB nurses on our team that do our OB transports. They also are sent through a critical care class and have to complete EMS time and OR time to obtain intubations so they can also work along the primary nurses on some of their calls. A lot to do, and they are great at it.

MickeymomRN · Jan 19, 2009

I work at a facility that transports OB patients from our facility to the high risk OB facility about an hour away. The nurses that work here are not all ACLS certified. Sometimes, ok, most of the time, the MFM requests that an RN accompanies the patient on ground transports. The ambulance that comes to pick up is ACLS but 1 EMT\1 EMT-P. When I started working here, I told the management that the nurses should be ACLS. They were also sending nurses that weren't high risk experienced. We're only a Level II NICU and hardly see anything high risk except PIH. The "old" nurses that have been here forever state "nothing has happened in the past". well, we all know that lawyers can't defend on past record. The requirements for transporting NICU patients is pretty tight. But for OB it's pretty hard to find. Does anyone have any resource that states the requirements/standards for an RN on OB transports?? I'm in FLA.

Medic09, BSN, RN, EMT-P · Jan 19, 2009

Lizzy, the real question is 'is there a High Risk OB/NICU Transport team in my area'? Clearly, specialty transports should be handled by specialty teams. Not every area has one available.

Here in NM, for example, the only OB/NICU teams available fly out of ABQ. They retrieve moms and babies from all over the state to the only NICUs in the state in ABQ. They also fly babies out of state for specialty care in LA, Palo Alto, etc. So what if an emergent transport is needed in the south end of the state, and the ABQ teams are already out? Well then, second choice will be to fly the patient with a regular RN/Paramedic HEMS crew. It just happens sometimes. Depends on where you are and what's available. At least the transport team didn't have the hubris to say 'hey, we've got this call let's just figure it out as we go along.' If they thought they might be in over their heads and the patient's welfare at stake, they did the right thing. I suspect we all agree on that last part.